The impact of the format of graphical presentation on health-related knowledge and treatment choices

Objective

To evaluate the ability of six graph formats to impart knowledge about treatment risks/benefits to low and high numeracy individuals.

Methods

Participants were randomized to receive numerical information about the risks and benefits of a hypothetical medical treatment in one of six graph formats. Each described the benefits of taking one of two drugs, as well as the risks of experiencing side effects. Main outcome variables were verbatim (specific numerical) and gist (general impression) knowledge. Participants were also asked to rate their perceptions of the graphical format and to choose a treatment.

Results

2412 participants completed the survey. Viewing a pictograph was associated with adequate levels of both types of knowledge, especially for lower numeracy individuals. Viewing tables was associated with a higher likelihood of having adequate verbatim knowledge vs. other formats (p < 0.001) but lower likelihood of having adequate gist knowledge (p < 0.05). All formats were positively received, but pictograph was trusted by both high and low numeracy respondents. Verbatim and gist knowledge were significantly (p < 0.01) associated with making a medically superior treatment choice.

Conclusion

Pictographs are the best format for communicating probabilistic information to patients in shared decision making environments, particularly among lower numeracy individuals.

Practice Implications

Providers can consider using pictographs to communicate risk and benefit information to patients of different numeracy levels.     

The impact of genetic testing for Crohn's disease, risk magnitude and graphical format on motivation to stop smoking: an experimental analogue study

Genetic tests may motivate risk-reducing behaviour more than other types of tests because they generate higher risk magnitudes and because their results have high personal relevance. To date, trial designs have not allowed the disentangling of the effects of these two factors. This analogue study examines the independent impacts of risk magnitude and provenance, and of risk display type, on motivation to quit smoking. A total of 180 smokers were randomly allocated to one of the 18 Crohn's disease risk vignettes in a 3 (risk provenance: family history. genetic test mutation positive. genetic test mutation negative) × 3 (risk magnitude: 3%, 6%, 50%) × 2 (display: grouped or dispersed icons) design. The 50% group had significantly higher intentions to quit than the 3% group. A significant risk provenance × magnitude interaction showed that participants in 50% or 6% groups were equally motivated, regardless of risk provenance, while participants in the 3% group had higher intentions associated with a mutation negative result than with a result based on family history alone. Grouped icon displays were more motivating than the dispersed icons. Using genetic tests to estimate risks of common complex conditions may not motivate behaviour change beyond the impact of the numerical risk estimates derived from such tests.     

The impact of head direction on lateralized choices of target and hand

We examined choices made by monkeys performing a task in which two food-well targets were positioned on either side of the monkey, and LEDs provided instructions on hand use and food target availability. We have previously reported that when gaze and head direction were unrestricted, lateralized choices were biased primarily by hand preference and secondarily by a preference to retrieve a target ipsilateral to the preferred hand. Here, we used a similar behavioral paradigm, but now during trial instructions the monkeys were required to maintain head direction aimed toward a left, a center, or a right fixation LED. When a lateralized head direction was required during presentation of the instructional cues, monkeys were more likely to choose the hand and target ipsilateral to the head direction. Lateralized head direction more strongly biased the monkeys’ choice of hand than their choice of target, but hand preference produced even stronger bias on target choices than did head direction. Although target cues were presented before hand cues, our data indicate that target and hand choices were made interactively. We also found that the monkeys’ choices were better correlated with their success rate for particular combinations of hand and target than with movement times.     

The graphical presentation of decision support information in an intelligent anaesthesia monitor

This contribution examines the graphical presentation of decision support information generated by an intelligent monitor, named SENTINEL, developed for use during anaesthesia. Clinicians make diagnoses in real-time during operations by examining clinically significant trends in multiple signals. SENTINEL attempts to mimic this decision process by using a system of fuzzy trend templates. SENTINEL's implementation of fuzzy trend templates is capable of providing the dual fuzzy measures of belief and plausibility, which are derived from the theory of evidence. It is thus capable of generating fairly rich diagnostic decision support information. However, for SENTINEL to be effective, the visual presentation of this information must be intuitive to the anaesthetist, who may not be familiar with the theory of evidence.This paper discusses techniques that are being evaluated to meet the requirements of the SENTINEL anaesthesia monitor. Specifically, the paper presents methods for highlighting clinically significant trends in physiological (or derived) signals by superimposing a coloured band on the signal that reflects fuzzy output from the intelligent monitor. This paper also discusses the intuitive graphical presentation of binary diagnostic fuzzy measures, including their further interpretation and presentation as crisp "alarm" and "warning" conditions.     

The effect of encoding on false memory: examination on levels of processing and list presentation format

Using the Deese/Roediger-McDermott paradigm, the effects of lists presentation format (blocked/random) and levels of processing of critical nonpresented lures were examined. A levels-of-processing effect in a blocked presentation order was not observed for lures. Rates of false recognition and remember judgments for lures in a shallow level of processing were significantly lower than those in a deep level of processing when items from various themes were inter-mixed instead of blocked. Results showed an interaction between levels of processing and list presentation format. It is thus concluded that encoding of each word and whole list should be both considered in understanding false memory.     

Communicating risk information: the influence of graphical display format on quantitative information perception-Accuracy, comprehension and preferences

OBJECTIVE: Statistical health risk information has proved notoriously confusing and difficult to understand. While past research indicates that presenting risk information in a frequency format is superior to relative risk and probability formats, the optimal characteristics of frequency formats are still unclear. The aim of this study is to determine the features of 1000 person frequency diagrams (pictographs) which result in the greatest speed and accuracy of graphical perception. METHODS: Participants estimated the difference in chance of survival when taking or not taking Drug A, on a pictograph format, varying by mode (one-graph/two-graph), direction (vertical/horizontal), and shading (shaded/unshaded), and their preferences for the different formats. Their understanding of different components of the 1000 person diagram was assessed. Responses were timed and scored for accuracy. RESULTS: Horizontal pictographs were perceived faster and more accurately than vertical formats. Two-graph pictographs were perceived faster than one-graph formats. Shading reduced response time in two-graph formats, but increased response times in one-graph formats. Shaded and one-graph pictographs were preferred. CONCLUSIONS: As shading and one-graph formats were preferred, further clarification as to why shading negatively impacts on response times in the one-graph format is warranted. PRACTICE IMPLICATIONS: Horizontal pictographs are optimal.     

Getting more people on the stairs: the impact of a new message format

Previous research has found that poster prompts are associated with significant increases in stair use. The present study examined the use of messages on the stair risers, as an alternative to posters, to encourage stair climbing. Observers monitored shoppers' stair and escalator use over a 2-week baseline and 6-week intervention period. The prevalence of stair use increased from a baseline value of 8.1 percent to 18.3 percent when the motivating messages were in place. This increase is greater than that found in studies that used poster prompts in shopping centre venues. The apparent advantage of stair-riser banners is discussed in terms of their visibility and attractiveness, as well as their capacity to present multiple messages likely to appeal to a broader constituency. It is concluded that promoters of physical activity should use colourful, tailored stair-riser banners, rather than posters, to encourage stair climbing.     

A comparative evaluation of the effect of internet-based CME delivery format on satisfaction,knowledge and confidence

Background  

Internet-based instruction in continuing medical education (CME) has been associated with favorable outcomes. However, more direct comparative studies of different Internet-based interventions, instructional methods, presentation formats, and approaches to implementation are needed. The purpose of this study was to conduct a comparative evaluation of two Internet-based CME delivery formats and the effect on satisfaction, knowledge and confidence outcomes.     

The impact of disease-related impairments on disability and health-related quality of life: a systematic review

Background  

To investigate the interchangeability of measures of disability and health-related quality of life (HRQL) by comparing their associations patterns with disease-related impairment measures in patients with a variety of conditions.     

The impact of biologic agents on health-related quality of life outcomes in patients with psoriasis

Introduction: Psoriasis is a common, immune-mediated skin disease often associated with significant physical and psychosocial impairment. Antipsoriatic biologic agents offer patients unparalleled treatment potential in regard to greater skin clearance and overall improved quality of life. Evaluation of the therapeutic efficacy of biologic agents on the full psoriasis disease burden must account for their impact on both physical symptoms, as well as patient-reported, health-related quality of life (HRQoL) measurements.

Areas covered: Results from numerous clinical trials demonstrate the significant clinical efficacy of biological agents targeting tumor necrosis factor-α (TNF-α) and the interleukin (IL)-12/23 and IL-17 immune pathways. However, relatively limited data is available evaluating their full effect on quality of life outcomes. This review will discuss the most relevant and up-to-date clinical data on HRQoL measurements related to treatment with these aforementioned biologic agents.

Expert commentary: Patient-reported outcomes (i.e. Dermatology Life Quality Index) are being used with increasing frequency in clinical trials, and provide valuable information on the impact of psoriasis on numerous aspects of day-to-day living. These outcomes must also be incorporated in clinical practice, in addition to physical assessment of disease severity, treatment decisions, and therapeutic response in the psoriasis patient population.     

The impact on behavioral training upon the knowledge and effectiveness of juvenile probation officers and volunteers

The feasibility of studying the effects of behavioral training for probation workers upon both the workers and their probationers was examined by randomly assigning ten probation officers and volunteers to a training group and a control group. Pre-and post-tests were administered to assess the knowledge and competence of the probation workers, various kinds of problem behaviors that the workers and parents observed in the delinquent youth, and various kinds of problem behaviors that the youth observed in themselves. The training included both didactic and experiential elements. The behavioral training significantly improved the knowledge and the competetnce of the probation workers and significantly decreased the number of problem behaviors observed by both the workers and the parents. No evidence was found that the workers' behavioral training affected the number of problem behaviors that the youth observed in themselves. The difficulties of conducting such a study are discussed along with recommendations for addressing these difficulties in future research.     

The impact on health-related quality of life from non-steroidal anti-inflammatory drugs, methotrexate, or steroids in treatment for juvenile idiopathic arthritis

OBJECTIVE: To assess and compare the impact of medication treatments on health-related quality of life (HRQOL), family function, and medical status in children with juvenile idiopathic arthritis (JIA). METHODS: Fifty-seven children diagnosed with JIA were assessed by a pediatric rheumatologist and placed into one of three treatment groups: (1) non-steroidal anti-inflammatory; (2) methotrexate; or (3) steroids via IV methylprednisolone. Questionnaires were administered at baseline and 4-month follow-up. The attending pediatric rheumatologist provided additional medical information. RESULTS: Data document the impact of JIA on HRQOL, particularly on physical and pain domains. Steroid patients experienced improved HRQOL at follow-up relative to other groups, despite reporting more problems with side effects. CONCLUSION: These results demonstrate positive benefits of steroids in treating JIA children, despite the greatest incidence of adverse side effects.     

The specificity of proteasomes: impact on MHC class I processing and presentation of antigens

Summary: We have studied polypeptide processing by purified proteasomes, with regard to proteolytic specificity and cytotoxic T-lymphocyte (CTL) epitope generation. Owing to defined preferences with respect to cleavage sites and fragment length, proteasomes degrade polypeptide substrates into cohorts of overlapping oligopeptides. Many of the proteolytic fragmetits exhibit structural features in common with major histocompatibility complex (MHC) class I ligands including fragment size and frequencies of amitio acids at fragment boundaries. Proteasomes frequently generate definitive MHC class I ligands and/or slightly longer peptides, while substantially larger peptides are rare. Individual CTL epitopes are produced in widely varying amounts, often consistent with immunohier-archies among CTL epitopes. We further found that polypeptide processing is remarkably conserved among proteasomes of enkaryotic origin and that invertebrate proteasomes can efficiently produce known high-copy MHC class I ligands, suggesting evolutionary adaptation of the transporter associated with antigen processing and MHC class I to ancient constraints imposed by proteasomal protein' degradation.     

The impact of treatment on the natural history of endometriosis

A group of 50 infertile female patients was assessed laparoscopically to study the natural history of endometriosis. They were treated either with danazol (n = 21), or diathermy ablation (n = 13) or had conservative surgery with postoperative danazol (n = 5) or were left untreated (n = 11). All these patients had second look laparoscopy performed after a mean interval of 12 months (range 9-18 months). Improvement was noted among 53% of those treated with danazol, 70% treated with diathermy, 80% treated with surgery and danazol and 27% of those left untreated. The status of endometriosis remained unchanged among 14% of those treated with danazol, 8% treated by diathermy and 9% of those left untreated. However, the disease became worse in the remaining women, 33% in the danazol treated group, 22% treated by diathermy, 20% treated with surgery and danazol and 64% of those left untreated. Thus treatment hinders progression in a majority of patients, and conversely, there is a small but definite spontaneous regression rate.     

The impact of the profile of biologics on treatment costs

In the perspective of the payer, it is important to know the details concerning the management costs of biological drugs in an effort to optimise expenditures. We have therefore examined how the expenditure varies with regard to the purchase of biologics, the mode of administration, and the management of serious adverse events secondary to the use of various drugs. The average expenditure for the purchase of the drug, including VAT, is € 12,005, while expenditures for the administration and management of serious adverse events are minimal, i.e. € 32 and € 124, respectively. An analysis of how the cost of various items affects the overall cost revealed no significant differences that would steer the choice towards one biologic drug rather than another.     

The role of therapeutic format in the treatment of sexual dysfunction: A review

Review of the literature evaluating different formats for the delivery of behavioral sex therapy suggests that group therapy, minimal therapist contact bibliotherapy, and standard couple therapy all have demonstrable effectiveness; such differences as have been found between them have been subtle. Variations within these formats indicate that one therapist is as effective as two, the render of the therapist does not influence therapeutic outcome, and that massed and spaced sessions, with minimal exceptions, produce equivalent therapeutic effects. The authors argue, however, that it is premature to conclude that all therapeutic contexts are equally effective. Human sexual response is complex, therapy programs are multifaceted, and therapy outcome may be measured in multiple ways, yielding dramatically different results, judgments regarding therapeutic effectiveness will vary as well depending upon whether cognitive, affective or behavioral therapy outcome criteria are employed. Adequate evaluation of therapy as a function of mode of therapy delivery must take these considerations into account.     

HIV/AIDS' spread and impact on other health-related millennium development goals--secondary publication

HIV/AIDS threatens the development of countries with high HIV prevalence. This article focuses on the magnitude of the impact of HIV/AIDS on the millennium development goals (MDGs) for health. The article is based on a literature survey on the impact of HIV on child health, maternal mortality, tuberculosis (TB) and malaria. At global level 10% of child mortality is related to HIV/AIDS but the impact of HIV/AIDS on child mortality is much higher in high HIV prevalence countries being measured in the range of 27-42%. The impact on maternal mortality is difficult to estimate since the majority of pregnant women are not tested for HIV, but studies in a number of HIV high prevalence countries indicate an increasing negative impact on maternal mortality. The impact of HIV/AIDS on TB is significant. 9% of the TB cases are related to HIV/AIDS at the global level, but for the WHO African region alone, the impact of HIV/AIDS is estimated at 31%. There is evidence that HIV infections increase the risk for the progression of malaria in children and the risk of severe and complicated malaria in adults in stable malaria areas. However, the most evident effect of HIV on malaria is related to pregnant women. It is concluded that strategies to reach the MDGs for health must include a comprehensive and coordinated approach to fight the major health problems including a more suitable resource allocation and organisation of health services taking into account the many inter-linkages between diseases.     

Methodological choices in experimental research on medical communication using vignettes: The impact of gender congruence and vignette modality

ObjectiveExperimental vignette designs are used to systematically test the effects of medical communication. We tested the impact of two methodological choices –gender congruence and vignette modality– on analogue patient reported outcomes.MethodsIn an online experiment using a vignette portraying an oncological bad news consultation, we manipulated (1) gender congruence between the analogue and the vignette patient, and (2) vignette modality, i.e., text, audio, or video. Cancer-naïve students acting as analogue patients (N = 209, 22 ± 3 years old, 75% F) were assigned one randomly-selected vignette variant and completed questionnaires. Using 3 × 2 (repeated-measures) ANOVAs, we tested main and interaction effects of gender congruence and modality on self-reported engagement, recall, trust, satisfaction and anxiety.ResultsWe found no main effects of gender congruence or modality on any of the outcomes, nor any interaction effects between modality and congruence.ConclusionOur results indicate that researchers may needlessly create gender-congruent vignettes at considerable cost and effort. Also, the currently assumed superiority of videos over other modalities for experimental vignette-based research may be inaccurate.Practice implicationsAlthough further testing in an offline format and among different populations is warranted, decisions regarding gender congruence and modality for future vignette-based studies should be based primarily on their specific aims.     

A focus group study on breast cancer risk presentation: one format does not fit all

Identifying a strategy that would optimize both the communication and understanding of the individual breast cancer risk remains a considerable challenge. This study explored the preferences of women with a family history of breast cancer about six presentation formats of individual breast cancer risk, as calculated from a risk prediction model. Thirty-four unaffected women attending genetic counseling because of a family history of breast cancer participated in six focus groups conducted in Québec City (2), Montréal (2) and Toronto (2), Canada. Six risk formats were presented for a fictitious case involving a 35-year-old woman (1—numerical: cumulative risk probabilities by age until 80 years; 2—risk curves: probabilities expressed in a risk curve that also provided a risk curve for a woman with no family history in first-degree relatives; 3—relative risk of breast cancer by age 80 years; 4 and 5—absolute risk of breast cancer and absolute chance of not developing breast cancer in the next 20 years; 6—qualitative: color-coded figure). Participants were asked to indicate their appreciation of each format. A group discussion followed during which participants commented on each format. The most and least appreciated formats were risk curves and relative risk, respectively. Overall, participants advocated the use of formats that combine quantitative, qualitative and visual features. Using a combination of approaches to communicate individual breast cancer risks could be associated with higher satisfaction of counselees. Given the increasing use of risk prediction models, it may be relevant to consider the preferences of both the counselee and the professional.     

The impact of depression and fluoxetine treatment on obstetrical outcome

Summary Introduction: This study prospectively followed women over the course of pregnancy to assess the impact of depression and/or antidepressant treatment on obstetrical outcome.Method: Sixty-four outpatient women with an Axis I diagnosis of major depressive disorder or no psychiatric history were followed in each trimester of pregnancy with administration of the CES-D. A subset of the women with depression received treatment with fluoxetine during pregnancy. Subjects with a CES-D score greater than 16 at any time point were further assessed for the presence of an active major or minor depressive episode. Primary outcome variables included infant gestational age, birth weight, Apgar score, and admission to the neonatal intensive care unit.Results: Analyzable data were available for 62 women. No significant differences were found in outcome variables between those women with exposure to medication and/or prenatal depressed mood and those women without a history of depression.Conclusions: In contrast to other studies, our study did not demonstrate an adverse effect of fluoxetine exposure per se on obstetrical outcome. In addition, we did not find a significant impact of depression during pregnancy on obstetrical outcome.